Healthcare Provider Details

I. General information

NPI: 1508688268
Provider Name (Legal Business Name): ALEXANDER PALACHE GUTTERMAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AVON ST
KEENE NH
03431-3516
US

IV. Provider business mailing address

40 AVON ST
KEENE NH
03431-3516
US

V. Phone/Fax

Practice location:
  • Phone: 603-357-4400
  • Fax:
Mailing address:
  • Phone: 603-357-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0020050
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: